人工通气在院前心肺复苏中作用的动物实验研究  

The efficiency of ventilation in out-of-hospital cardiopulmonary resuscitation： ananimal study

作　　者：梁立秋[1] 郭晓丽[1] 李海波[1] 

机构地区：[1]哈尔滨医科大学附属第二医院重症医学科,150086

出　　处：《国际麻醉学与复苏杂志》2017年第4期323-328,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的通过对不同原因心搏骤停（cardiac arrest，CA）大鼠实施传统心肺复苏（cardiopulmonary resuscitation，CPR）及单纯胸外按压CPR，探讨人工通气在院前CPR中的作用。方法选用健康成年SD大鼠45只，按随机数字表法分为5组：窒息-传统复苏组（A组，lO只）、窒息．单纯按压组（B组，10只）、心室纤颤一传统复苏组（C组，10只）、心室纤颤一单纯按压组（D组，10只）、假手术组（Sham组，5只）。A组、B组采用窒息法致CA模型，C组、D组采用经食管电起搏法致CA。CA 4 min后进行8min旁观者CPR：A组、C组给予传统CPR（按压：通气=30：2），B组、D组给予单纯胸外按压CPR。8min未恢复自主循环（return of spontaneous circulation，ROSC）者给予高级生命支持（advanced life support，ALS），经ALS10rain未ROSC者停止复苏。ROSC者给予复苏后治疗1h，养活24h后取大脑、心室壁、肺右下叶组织标本，24h内死亡者，于死亡时取上述标本。Sham组不诱发CA，仅给予监测生命体征1h，24h后采集组织标本。比较各组ROSC率、24h存活率，不同时间点血气分析指标及组织损伤程度。结果ROSC率比较，A组、C组均高于B组、D组，但差异无统计学意义（P〉O．05）；24h存活率比较，A组、C组均显著高于B组、D组（P〈O．05）；病理检查结果显示，A组、C组较B组、D组组织损伤程度更轻。结论传统CPR比单纯胸外按压CPR更能提高心室纤颤性及窒息性CA大鼠的24h存活率，因此，无论心源性还是非心源性院外CA，采用传统CPR法进行基础生命支持更能改善预后。Objective To study the efficiency of ventilationin in out-of-hospital cardiopulmonary resuscitation （CPR） by performing compression-only CPR or conventional CPR in rats of different causes of cardiac arrest （CA）. Methods Forty five SD rats were randomly divided into 5 groups： asphyxia-conventional group（group A, n=10）, asphyxia-compression-only group（group B, n= 10）, ventricular fibrillation-conventional group （group C, n=10）, ventricular fibrillation-compression-only group （group D, n=10）, group sham （n=5）. The model of asphyxial CA was made by clamping endotracheal tube at expiration in group A and group B. The model of ventricular fibrillation CA was made by transoesophageal cardiac pacing in group C and group D. Bystander CPR was initiated 4 min later. Conventional CPR （compression ： ventilation =30 ： 2） was performed in group A and group C, compression -only CPR was performed in group B and group D. For animals that did not attain return of spontaneous circulation （ROSC） during the 8 min bystander CPR period, advanced life support（ALS） was provided. The animals which did not attain ROSC after 10 min ALS should be given up. The pathological specimens of brain, ventricular wall and right lower lobe of the lung were collected after 24 h, and the samples were collected in the death of 24 h. Post-resuscitation treatment had been performed in all successfully resuscitated animals for 1 h. At 24 h after ROSC, rats were sacrificed for histological analysis. The vilai signs was monitored for l h in goup sham, rats were sacrificed for histological analysis after survival 24 h. The major outcome measure was rates of ROSC, and the secondary was the survival rates of 24 h. Blood samples were drawn for blood gas analysis during resuscitation in the pathologic findings. Results Rates of ROSC were higher in group A and group C compared with group B and group D, but the difference was not significant. Survival rates of 24 h were compared, group A and group C were significantly hi

关 键 词：心搏骤停 心肺复苏 人工通气 

分 类 号：R459.7[医药卫生—急诊医学]